With surge in retirements, GHC's family doctor crisis at critical stage

The availability of family doctors at one of Sault Ste. Marie’s main healthcare facilities could be described as in critical condition.

Many family doctors at Group Health Centre are retiring without young doctors to replace them.

“The severe shortage of primary care providers is impacting every community across Ontario. The root cause of the challenge facing communities across the province is a demographic issue – simply put, there are not nearly enough PCPs entering the workforce to replace the ones who have retired or are planning to retire in the near future,” wrote Giordan Zin, Group Health Centre communications manager in an email to SooToday.

While the Group Health Centre owns GHC buildings and medical equipment, employs staff - except physicians - and serves as keeper of patient health information, it is the Algoma District Medical Group that recruits doctors and rosters patients.

As things currently stand, the Algoma District Medical Group and Group Health Centre must recruit 10 new doctors within the next two years to balance patient rosters as more doctors approach retirement, Zin wrote.

At present there are approximately 57,000 patients assigned to 54 family doctors with ADMG/GHC. 

Of those 54 doctors:

• 36 physicians practice full-time family medicine – 10 of them, or 28 per cent, are over the age of 58
• Nine locum physicians have been temporarily contracted to provide family medicine  - seven of that nine, or 78 per cent of those locums, are over the age of 60

Four additional family medicine locums have been temporarily contracted to support GHC’s Same Day Clinic while GHC also has five nurse practitioners practicing family medicine full-time.

Almost 32 per cent, or 17, of GHC’s family doctors are closing in on retirement or are over the age of retirement.

“ADMG/GHC is facing a serious recruitment crisis, not unlike every other primary care clinic in Ontario,” Zin wrote.

Concerning patients who have been ‘orphaned’ - or left without a family doctor when their physician retires - Zin wrote that GHC has, in the past, enjoyed some success in ensuring that doesn't happen.

That was due to a steady flow of Northern Ontario School of Medicine graduates interested in family medicine coming to GHC to take the place of retiring family doctors.

Other ways included the use of long-term locums to care for patients until new doctors were recruited, as well as convincing retired doctors to return to practice on a part-time or full-time basis. 

From 2018 to 2022, ADMG/GHC recruited 10 family doctors with ties to NOSM, eight of whom graduated from the NOSM Sault Ste. Marie Family Medicine Residency Stream. Another three were recruited that had no ties to NOSM.

But that was in the past.

“In recent years, interest in the local NOSM Family Medicine Residency Stream has declined,” Zin wrote.

“Regrettably, with the size of ADMG/GHC’s existing roster - approximately 57,000 patients - the lack of PCPs entering the field of family medicine, and the looming number of retirements on the horizon, we recently had to start making the very difficult decision to start to de-roster patients when an ADMG/GHC PCP retires or chooses to leave their practice.”

“We did not make this decision lightly, as we fully recognize the impact that losing access to a primary care provider can have on a patient and their family. However, the unfortunate reality is that the temporary measures we put in place over the years as a stopgap solution are no longer sustainable,” Zin wrote.

Without enough new family doctors joining GHC, the facility won’t have the resources to care for patients whose doctors retire.

“2,823 patients were de-rostered or ‘orphaned’ over the last six years due to a lack of available PCPs. Unfortunately, given that almost 32 per cent of our current PCPs are nearing, at, or over the age of retirement, and the average roster size for ADMG/GHC PCPs is 1,400 patients, we anticipate that this number will grow considerably over the next few years,” Zin wrote.

While stating the outlook is “bleak,” Zin stated that “ADMG/GHC and the rest of our community healthcare partners remain focused on recruiting as many physicians and nurse practitioners as we can. As a community, we are in regular contact with those medical students who are training in Northern Ontario. While NOSM has been a reliable source of PCP graduates, we also recruit grads from the other Family Medicine programs offered in Ontario.” 

Sault healthcare administrators are working on recruiting doctors from outside Ontario and outside of Canada to revive family medicine in the city.

“We have recruited 10 physicians to date this fiscal year,” said Christine Pagnucco, Sault Ste. Marie Physician Recruitment and Retention Program manager in an email to SooToday.

Those physicians include two doctors in family medicine, two emergency department doctors and one specialist each in urology, oncology, critical care and internal medicine, interventional cardiology, pediatrics and an obstetrician/gynecologist.

“Recruitment of Family Medicine physicians remains a critical priority as we continue to see retirements throughout the year, Pagnucco wrote.

The Ontario College of Family Physicians reported in Feb. 2023 that 2.2 million Ontarians are now without a family doctor, up from a previously reported 1.8 million.

The OCFP - to name just one professional organization - has stated that more people could be attracted to practicing family medicine if more nurses, mental health workers and social workers were brought on board to assist doctors in caring for patients, lessening the amount of time doctors spend on paperwork, fast tracking more foreign trained doctors to practice in Ontario and increasing the number of family medicine spots in the province's medical schools. 

Meanwhile, an increasing number of Saultites without access to a family doctor spend time at Sault Area Hospital’s Emergency Department, GHC’s same day clinic or walk-in appointments at various clinics around town.